Definition, Measurement, Precursors, and Outcomes of Trust Within Health Care Teams: A Scoping Review

Categorising drivers of curriculum renewal in entry-to-practice health professional education: A scoping review

INTRODUCTION

Renewing a health professional education (HPE) curriculum is a significant undertaking, requiring substantial effort and resourcing. However, the factor(s) that should initiate a curriculum renewal remain contentious, and the methods to best assess them are unclear. To begin answering these questions, a comprehensive view of the scope of potential renewal drivers is needed, thus enabling structured inquiry into these (and their interactions) while ensuring no driver categories are being inadvertently overlooked. It would similarly serve as an important checklist for individual institutions undergoing renewal. However, no such list has ever been formulated in a data-driven way. Thus, this scoping review aimed to document the full range of real-world drivers of HPE curricular renewal and create an overarching categorisation of these.

METHODS

A systematic search was conducted of the Embase, Medline/PubMed, Global health and CINAHL databases for studies published between 2013 and 2023 describing a completed single-institution curriculum renewal of an entry-to-practice HPE degree. Following independent screening, articles were reviewed and 'extent of renewal', 'renewal characteristics' and the 'initiating driver(s)' of renewal were extracted. Descriptive statistics were generated, and qualitative content analysis performed to generate a categorisation of renewal-initiating drivers.

RESULTS

The search identified 1408 potential manuscripts, and 239 publications describing 247 renewals were analysed. Forty percent were whole-of-degree renewals. Institutions from all continents were represented. Seventy-seven initiating drivers were identified and grouped into 10 categories: 'Regulatory reasons', 'Pedagogical improvements', 'Community/patient needs', 'Learner experience/satisfaction', 'Exceptional events', 'Learner outcomes', 'Industry benchmarking/reputation', 'Practical/business factors', 'Knowledge/skill issues' and 'Periodic renewals'. 'Regulatory reasons' were the most common reason for whole-of-degree renewals and 'knowledge/skill issues' for part-of-degree renewals.

CONCLUSIONS

HPE curricula renewals have a wide range of initiating drivers. The proposed categorisation of these should serve as a useful scaffold for institutional curricular review processes and also for directing future scholarly inquiry into curricular renewal.

Factors influencing trust among colleagues in hospital settings: a systematic review

BACKGROUND

Many studies show positive results of collegial trust in the workplace, e.g. performance, innovation and collaboration. However, no systematic review on collegial trust in hospital settings exists. This study aimed to provide the missing overview of factors that positively and negatively influence this trust relationship between healthcare providers.

METHODS

Ten information sources (Web of Science, Embase, MEDLINE, APA PsycInfo, CINAHL, Scopus, EconLit, Taylor & Francis Online, SAGE Journals and Springer Link) were searched from database inception up until October 21st, 2022. Empirical studies included were written in English, undertaken in a hospital or similar setting, and addressed collegial trust relationships between healthcare professionals, without date restrictions. Studies were excluded if they only explored trust between healthcare professionals on different hierarchical levels. Theoretical studies, systematic reviews, conceptually unclear papers and anecdotal case studies were also excluded. Records were independently screened for eligibility by at least two researchers. A narrative synthesis technique was adopted to explore and discuss the influencing factors of trust between colleagues identified across both quantitative and qualitative studies. This method was chosen given the inclusion of studies with different research designs and the unsuitability of the data for a meta-analysis or meta-ethnography. Risk of bias was assessed independently by at least two researchers using four critical appraisal tools.

RESULTS

Eight thousand two hundred sixty-eight studies were screened and 11 studies were included. Seven were qualitative and four were quantitative. Themes identified were professional competence, elements of communication, such as tacit knowledge sharing, and ethical conduct, such as honesty, confidentiality and accountability. Moreover, trust among colleagues was seen to thrive in work environments characterised by psychological safety. The results of the quality assessment show that most studies were of an acceptable quality, with some associated risk of bias. One of the limitations was represented by the lack of a definition for trust in some studies, and some inconsistency for those studies that did define trust.

CONCLUSIONS

Professionalism, communication and ethics were seen as the most important factors enhancing trust. However, these concepts were defined differently in the studies.

TRIAL REGISTRATION

PROSPERO; CRD42023433021.

Qualitative investigation of military surgical resuscitation teams: what are the drivers of success of a rapid response team?

OBJECTIVES

This qualitative study explores the characteristics of a specialised military medical rapid response team (MRRT), the surgical resuscitation team (SRT). Despite mixed evidence of efficacy, civilian MRRTs are widely employed, with significant variation in structure and function. Recent increased use of these teams to mitigate patient risk in challenging healthcare scenarios, such as global pandemics, mass casualty events and resource-constrained health systems, mandates a reconceptualisation of how civilian MRRTs are created, trained and used. Here, we study the core functions and foundational underpinnings of SRTs and discuss how civilian MRRTs might learn from their military counterparts.

DESIGN

Semistructured interview-based study using Descriptive Qualitative Research methodology and Thematic Analysis.

SETTING

Remote audio interviews conducted via Zoom.

PARTICIPANTS

Participants included 15 members of the United States Special Operations Command SRTs, representing all medical specialties of the SRT as well as operational planners.

RESULTS

Adaptability was identified as a core function of SRTs and informed by four foundational underpinnings: mission variability, shared values and principles, interpersonal and organisational trust and highly effective teaming. Our findings provide three important insights for civilian MRRTs: (1) team member roles should not be defined by silos of professional specialisation, (2) trust is a key factor in the teaming process and (3) team principles and values result in and are reinforced by organisational trust.

CONCLUSION

This study offers the first in-depth investigation of a unique military MRRT. Important insights that may offer benefit to civilian MRRT practices include enabling the breakdown of traditional division of labour, allowing for and promoting deep interpersonal and professional familiarity, and facilitating a cycle of positive reinforcement between teams and organisations. Future investigation of small team limitations, comparability to civilian MRRTs, and the team relationship to the larger organisation are needed to better understand how these teams function in a healthcare system and translate to civilian practice.